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v) r <br /> o- <br /> a fD g <br /> cn <br /> SHORT-TERM RENTAL LICENSE APPLICATION— Burnett County, WI N: CD = <br /> s <br /> G <br /> Applicant Complete All Sections Below This Line ° <br /> g <br /> Original License Fee= $300 Renewal License Fee(Annually)_$150 v_ 1 Fi <br /> Fi <br /> Jl Zl� <br /> Property Owner's Name:Noah & Amy Shadis a 1- y <br /> Property Owner's Mailing Address: 234 Van Buren Ave N Ho•kins MN 55343 ° W kj <br /> City State Zip ; ' W <br /> Property Site Address:27893 N Point Lake Rd,Webster,WI 54893 g r; Q <br /> Applicant's Telephone Number: 763-221-9287 r -` <br /> h.shadis mail.com noa n <br /> Applicant's Email:noah.shadis@gmail.com <br /> 13 of CSM V5 P191 (#204054)Map#1082 S28 T4ON R15W CSM V5P 191 <br /> Legal Description of Property: Parcel ID#07-012-2-40-15-28-5 05-001-015000 <br /> Section#: 28 Town#: 40 N Range#: 15 W Town of:Jackson N W s <br /> *Attach additional page if needed for lengthy description OR attach a copy of the deed OR attach tax system property page.* aso '; <br /> CJ D o <br /> Tax ID#(1-5 digit number;found on tax statement):_5811 5. 'D N <br /> L <br /> Provide Rental Information <br /> License Year Applied For:2023 Amount of Renters Applied For: 4Local Contact's Name: Dan ShadisLocal Contact's Address: 509 N Park St Grantsburg WI 54840 <br /> City State Zip W <br /> Local Contact's Telephone Number: 715-463-5408 <br /> Most Recent Burnett Coun License Number: STR- State License Number: <br /> ty 2 2- "? rfn6N'CH S1- Al N <br /> AREA BELOW THIS LINE FOR LAND SERVICES STAFF COMMENTS/CONDITIONS ONLY <br /> THIS LICENSE IS SUBJECT TO ALL CONDITIONS LISTED BELOW: <br /> - i(:� nk -e (e S l3 /Z29 *� 1 S $Qe �S464 by le I 3 0 = <br /> - DCLwal ouk6 s-f+;se rn1.n.+ rw+- -b eX. Li r-wpl-e-- <br /> -/AGk. arid c- kaA0 ba S-e p-1-=c- a+ w -h ate_ cn <br /> -wevtb id, shorelanvd rts-wr ;-bn -Flamm 20 l 7e.rr►li-1~- <br /> e ', i <br /> r`' H <br /> -> i l)k- ((S+ 20 ' C it ax em ce_ -o .:nti r of h 1 c.LLS rm Fee Rec: 1�� <br /> -3\ 0n V (cQ,1 COAno{- bz tI 4 ku,man h.r l-t thou quid beds mom- be t�erru�t� ek#: �2�Fs <br /> 2 p ' Ir <br /> Date of staff site visit: /0 /Zo73 I itials of site visit staff: 17L -- Fi <br /> 4 /-ez3 <br /> LICENSE APPROVED BY 2/ <br /> DATE: 11 ` I/ �(/ s li1 E <br /> LAND SERVICES OFFICIAL ! m W E - l! <br /> M ci m ,' <br /> 5 g2 v� o f <br /> IV <br /> Pagelof3 o w'< w <br /> Burnett County,WI Short-Term Rental License Application-Rev 03-2022Fitil <br />